



CHOLERA; 



ITS 



History, Cause and Prevention. 



ERRATA. 

On page 37, near the end of the 10th line 
from the top, after the word "that" insert the 
words " in a cholera season." 

On page 69, at the end of the 15th line from 
the top, after the word "any" insert the word 
"is." 

On page 96, in the 9th line from the top, the 
quotation marks after the word "air" should 
have been placed before the word " The ' ' in the 
same line. 



PRICE 30 CENTS. 



Cholera ; 



ITS 



Histoty, Cause and Prevention. 

BY 
EZRA A. BARTLETT, M. D. 






ALBANY, NT ®" 

H. H. Bender, 71 and 73 State St. 

1885. 



1 

I,VI.Y>. '" 






Entered according to Act of Congress, in the year one thousand eight 
hundred and eighty-live, bv 

II. II. BENDER, 

in the office of the Librarian of Congres.-, at Washington, D. C . 



PREFACE. 



The actual existence of cholera, at the pres- 
ent time, in France and Spain, as indicated by 
its reappearance in Marseilles, Valencia, and 
other places, renders its appearance in this 
country very probable, and to know how to 
prevent it from spreading over onr land be- 
comes a matter of the utmost importance. A 
review of its history and causes, we believe, 
will contribute much toward this end; hence 
this little book. It is not designed to be an 
exhaustive treatise on the subject of cholera, 
neither is it a scientific monograph designed 
solely for the use of the medical profession. 
It is written for the people, and an effort has 
been made to place before them, in an unpre- 
tentious manner, the latest and best opinions. 
It is made of small size that it may serve as a 



4 Preface. 

companion to very many persons; and if by its 
study any considerable portion of the people 
are aroused to the importance of individual 
effort and cooperation with their Boards of 
Health in sanitary matters, its object will have 
been attained. While we are writing, reports 
come from across the water of the gratifying 
results of inocukition for the prevention of 
cholera. In time this may, perhaps, prove of 
as great value as vaccination, but for the pres- 
ent our reliance must be upon sanitation. 

The author desires to acknowledge his in- 
debtedness to other writers from whom he has 
freely quoted, but to whom he has endeavored 
to give due credit, and to say in this connection 
that the whole of the iifrh chapter was very 
kindly contributed by Dr. Willis G. Tucker, 
Professor of Inorganic and Analytical Chemis- 
try in the Albany Medical College. 

To Drs. Albert Van der Veer, Samuel B. 
Ward and Frederic C. Curtis, of this city, 
whose numerous courtesies have rendered the 
completion of the book possible in the short 
time allotted to the work, he tenders his sincere 
thanks. E. A. B. 

9 South Hatvk St., Albany, N. Y. 
June, 1885. 




: ^v^^«- 



CONTENTS, 



I. History of Cholera, 7 

II. Cause of Cholera, 31 

III. Propagation of Cholera, . ' . . 41 

IV. Prevention of Cholera, .... 54 
V. Hygiene of Food and Drink, . . 74 

VI. Disinfection 91 



CHAPTER I. 

CHOLEEA — ITS HISTOEY. 

Cholera is a disease which is looked upon 
by different persons with varying emotions; to 
those who have read of the terrible ravages 
produced by it in certain localities, or have 
seen the streets deserted, business suspended, 
and death regnant in a city, have heard the 
rattle of the death- cart as it bore to the hastily 
made grave, victim after victim of the fearful 
scourge, it produces feelings akin to terror. 
To those engrossed in business, with no 
thought but for the accumulation of wealth 
or position, it brings but a momentary anxi- 
ety, which is at once lost in the busy whirl, 
just as are the cry of the injured, the wail of 
the oppressed, and the moan of the smitten. 
But to those of the community who comprise 



8 Cholera. 

the considerate and earnest class; who regard 
the welfare of others as somehow very closely 
related to their own; who are accustomed to 
look upon life as a grand opportunity for the 
growth and development of the principles of 
good; and upon the various tribulations which 
come to individuals and peoples as in some 
way subserving this end, and, for this reason, 
to be manfully accepted, studied and made to 
divulge their secret, to such persons it brings 
much anxiety, is the cause of much serious 
reflection, but at the same time inspires to 
earnest work. Too much admiration cannot 
be felt for the army of patient investigators 
who, regardless of their own comfort, zealously 
labor to bring to light the hidden causes of 
evil, that they may be removed. It is inter- 
esting to study the reflections and review the 
work of such persons, and contemplate the 
advantages which accrue to society and the 
world by reason of them. In the history of 
cholera epidemics these facts are emphasized, 
for, as Dr. Simmons in his elaborate report of 



Its Histoey. 9 

the epidemics in Japan, quoting Macpherson, 
says, "It is one of the oldest diseases whereof 
a distinct description exists and there are few 
disorders respecting which such an uninter- 
rupted chain of evidence has been preserved;"* 
and we might go further and state that in this 
complete record we find the strongest evidence 
of the value of careful study into the nature 
and causes of those evils which produce wide- 
spread devastation and of the prompt applica- 
tion of such measures as reduce the evil to a 
minimum. Centuries ago it was looked upon 
as a visitation of the wrath of the gods and a 
means by which vengeance was wreaked upon 
unhappy mortals. When an epidemic was 
raging furiously the most abject terror seized 
upon the people and, they becoming panic 
stricken, nothing was done and they died by 
thousands. 

Later, in Japan, the disease was generally 
attributed to diabolical agency; "Hence the 
people gave it the name of 7co-ro-ri; that is, 

* Cholera Epidemics in Japan, by D. B. Simmons, M. D. 



10 Cholera. 

'fox, wolf, and badger.' It was also believed 
that all water and all fish were poison, so that 
people dared not draw water even from the 
pnre stream of the upper Tamagawa, nor eat 
any fresh fish, even when it was brought to 
their doors alive. Each one adorned his gate 
with branches of pine and bamboo, and straw 
ropes, and prayed that so dreadful a year 
might pass away as quickly as possible; some 
praying to kame and some to Buddha."* Lit- 
tle was known of it then except its fearful mor- 
tality; now the circumstances under which it 
thrives are most completely understood, and 
sanitary measures are undertaken which, in 
many instances, are sufficient to stamp it oiit 
at once. 

The disease is indigenous to Asia and, al- 
though attempts have been made to prove that 
the first cases in the epidemic which prevailed 
in some portions of France last year, originated 
de novo in that country, it is pretty generally 
regarded as an Asiatic disease, and appears in 

*Op. cit. 



Its History. 11 

other countries in accordance with the sequence 
of given circumstances. Away back in the 15th 
century it is reported to have existed, and de- 
scriptions by some of the medical solons of that 
period bring to our mind very clearly the so- 
called typical symptoms of Asiatic cholera, as 
we know them to-day. 

Cormack, in his "Studies," mentions the 
fact, as having been reported by Dr. John 
Webster, that in the days of Sydenham and 
Morton (1669-93) the population of London be- 
ing at the time (1669) but 600,000, the deaths 
from this disease were 4,385. But it is not 
quite certain that this was Asiatic cholera, and 
indeed the medical men of that day themselves 
called it cholera morbus. In Hindoo writings 
we have descriptions of it in the 16th and 17th 
centuries, but they are unreliable as they con- 
fuse other kindred diseases with it. During 
the years of 1768 to 1769 there was an epidemic 
of a disease closely resembling cholera which 
proved extensively fatal, carrying off some 
60,000 x^ersons. " On this occasion," as quoted 



12 Choleea. 

by Simmons, "the spread of the disease was 
so rapid, and the deaths so frequent, that the 
carpenters were unable to keep up with the 
demand for coffins, and empty sake casks had 
to be employed for the purpose. The grave- 
yards were at length all filled up, no space re- 
mained for more burials, and the priests of the 
various sects refused to permit the interment 
of the remains, insisting that the bodies should 
be burned and only the ashes buried. At the 
various cremation grounds, therefore, coffins 
in countless numbers were seen piled on top of 
each other; the burning of bodies being done 
in regular succession, according to the order of 
their arrival. Numbers of corpses, mostly of 
poor persons, had to be left unburied for up- 
wards of half a month, and the headman of 
the ward was at his wit's end to know what to 
do in the matter. They were finally, by order 
of the government, wrapped in mats and, 
after a brief religious ceremony, were conveyed 
to the Bay of Yedo, and sunk in the sea." 
But, coming down to the year 1817, we find 



Its History. 13 

reliable information to the effect that in this 
year the disease which had hitherto been con- 
fined to India, girded up its loins, overspread 
the whole peninsula, and penetrated wherever 
mortals lived, leaving in its course the ghastly 
corpses of millions of victims. For live years 
this giant stalked abroad; starting from Bengal 
he turned his face toward the setting sun; 
ascending the Granges, through Central India, 
across the Ghauts Mountains; in one year he 
reached the western coast of the peninsula. 
Then to the southward to Madras in 1819, 
crossed the sea to Ceylon, and during this year 
visited other islands of the sea. Ubiquitous or 
omnipresent, whichever he may be said to have 
been, the Island of Sumatra, the Peninsula of 
Mallaca, Siam and the Barman Dominions, did 
not escape his ravages. From having been in 
Northern China and Tartary in 1820, in 1821 
he appeared upon the shores of the Persian 
Gulf; from here he ascended the Tigris and 
the Euphrates, and in 1822 passed over the 
desert into Syria. Making his way northward 



14 Cholera. 

through Persia, he reached the shores of the 
Caspian Sea and captured the Russian City of 
Astracan in 1823. The whole of Asia having 
been made to pay tribute in victims to him, he 
disappeared, apparently satisfied with the de- 
vastation he had caused. But, like many 
another conquerer, his success on this cam- 
paign only whetted his desire for conquest. 
In 1828 we see him knocking at the doors 
before the town of Ohrenburg, in Russia, and 
in 1830 he entered the city of Moscow; no 
terrors of the conflagration were greater than 
those produced by his appearance. In the 
midst of gayest revelry the face was blanched 
by the midnight cry of mourning and of woe; 
where, but a few hours before, all had been 
prosperity and gladness, now there reigns a 
terror as of death. Through the streets of the 
city, into the hovel of the serf and the palace 
of the rich, he goes without let or hindrance, 
beckoning here the old grandfather, there the 
new-born babe, or again a whole family to fol- 
low him, making great seams and chasms in the 



Its Histoey. 



15 



hearts of thousands. Hastening on westward 
he attacked St. Petersburg, Warsaw, Dantzic, 
Berlin, Hamburg, and crossed to England in 
1831. 

He appears to have taken to himself the 
power of self-multiplication, for at this time 
he appears in Paris, London, Quebec and Mon- 
treal; he has overleaped the barrier presented 
by 3,000 miles of water and attacked a new con- 
tinent. As now we approach within the ken of 
those who are living to-day, and perhaps 
within the sacred precincts of some recollection 
saddened by the loss of friends, let us drop 
the figure and quietly follow the march of the 
terrible scourge. On the 24th of June, 1832, it 
appeared in New York and spread both north- 
wardly up the Hudson, and southwardly to 
the Delaware and Chesapeake Bay. About 
the time when, under other circumstances, the 
good old burghers in the city of Albany would, 
in their quiet old-time way, have been cele- 
brating the day of our Nation's pride, the 
authorities were busy devising means to stay 



16 Choleea. 

the approach of a disease which had already 
made havoc among the poor of their sister city 
The scourge found them as though it had 
come "like a thief in the night." They had 
neglected the proper precautions and the fell 
destroyer entered upon h is ghastly work The 
same is true of other cities in our fair land; 
Philadelphia, Baltimore and St. Louis were all 
sufferers that same month. For nearly two 
years there were a few cases here and there in 
this country and then it entirely disappeared. 
In the meantime Syria, Arabia and Egypt were 
invaded until, finally, having exhausted itself 
seemingly, the disease disappeared from view 
This was only its season of rest and recupera- 
tion however, for in 1847 accounts were received 
that it had a third time left its home in the 
delta 01 the Ganges, taken up its march of 
conquest and was pursuing the same route it 
had on previous occasions. Passing with 
terrible destruction through the cities of Persia 
it reached Astracan and Moscow, in which 
latter place it rested for the winter With 



Its History. 



17 



the advent of spring it attacked St. Peters- 
burgh, Berlin, Hamburg, Edinburgh and Lon- 
don; thence to New York and New Orleans. 
At the former American city it was checked 
by quarantine, but in New Orleans, the weather 
being very hot, and other things favorable for 
its reception and propagation, cases multiplied 
rapidly, and soon it had extended into Texas 
and up the Mississippi to Memphis. The next 
year (1849) following its appearance in Europe, 
it broke out in New York, Philadelphia and 
many other places on the Atlantic coast. 
Starting afresh in New Orleans, it overspread 
the valley of the Mississippi, took up its habi- 
tation with those who were toiling over the 
plains to their El Dorado, and caused many an 
one to stay his westward course and lay himself 
down to die amid the sage brush and the cactus. 
It reached Sacramento; it went even to the 
Golden Gate and there it rested. Not from 
thence departed, for during nearly six years 
there were cases frequently appearing in this 
country, milder exhibitions of the epidemic at 



IS Cholera. 

various points, until finally we find ourselves 
relieved of the oppressive visitor. A fourth 
time India sent her poisonous breath through- 
out the continent and slew more victims than 
the armies of Europe's conquering hero 
claimed. Reaching Mecca in 1865, the pesti- 
lence found a rare place in which to thrive. 
It is a sacred place and sacred season; Moham- 
med's loyal followers have met for worship at 
their shrine. Weary and worn by their long 
pilgrimage, poor in purse and wretched in con^ 
dition, they exist in the midst of squalor most 
profound. An official from the temple brings 
them "cakes of sacred bread; these cakes were 
made of meal, one- third of which is composed 
of sand and grit, and the remnants of obnox- 
ious insects. Another day the food is half- 
boiled rice, not cleared of gravel, bran or grit, 
and little cakes made of this with old and 
rancid glue. To render this food more sacred 
the cakes are kept in the temple for some days 
before they are consumed. Having been thus 
offered to the presiding deity of the place, they 



Its History. 19 

must be eaten by the pilgrims and that with 
apparent relish, for it is sacrilegious to exam- 
ine too closely the composition, and it is blas- 
phemy to find fault with it at all."* " The 
city of Mecca, lying in a basin, contains a 
permanent population of about 40,000 souls, 
and annually, during the Hadj (pilgrimage), 
from 100,000 to 150,000 pilgrims, who become 
residents for periods varying from one week 
to three months, crowd into it. This vast in- 
flux of strangers finds accommodation where it 
can; the well-to-do rent rooms, the poor live 
in the streets. The houses in Mecca are 
generally built in fiats to accommodate pil- 
grims; each flat is provided with one or two 
badly constructed latrines, and there are from 
six to twelve of these in each house. These 
latrines empty themselves into pits dug out- 
side the houses; when these get filled they 
are emptied into other pits, which are made in 
the streets or any other convenient spot, and 
then covered over with earth. For the poor 

* British Medical Journal. 



20 Cholera. 

latrines are made on the same principle, in and 
outside the town, and the same method of 
emptying them is employed. This system of 
burying foul matter in every direction has 
been pursued for centuries; it is not, therefore, 
surprising that the ground in and around 
Mecca is surcharged with excrementitious 
matter, which rains (these are frequent in 
Mecca) carry by filtration into the wells. One 
of the principal of these, and one most used, 
is called Hagar's well; it is not a spring, but 
its water is supplied by filtration— that is, by 
rain-water passing down through an overly- 
ing mass of foul matter. In addition to this, 
pilgrims by the thousand, sick and well, 
diseased and sound, daily wash beside it, when 
the water used naturally finds its way into the 
well."* What better allies could cholera have 
than such food, such water, such houses and 
such squalor? Re-enforced at this point, it 
passed into Egypt, making fearful ravages in 
Cairo and Alexandria. Dividing here, it 

* Medical and Surgical Reporter. 



Its Histoey. 21 

moved along the coast of Syria and Asia Minor 
up to Constantinople, encircling the Black Sea 
in its embrace; at the^same time visiting Italy 
it spread along the coast and into the interior. 
During the month of October it attacked 
Gibraltar, Barcelona, Madrid and other jDlaces 
in Spain, as also Marseilles, Toulon, Paris and 
other places in France, getting into England 
just as the frost came. From that time for- 
ward, for twelve' years, certain places were 
subject to outbreaks of cholera; in 1866-67 it 
made its appearance in New York but was at 
once stamped out. Too much praise cannot be 
awarded to the health authorities for the 
prompt and efficient action taken at that time; 
quite a large number of cases occurred in New 
York, Brooklyn and the harbor, but the 
spread of the disease was prevented and no 
panic was caused. Compared with the epi- 
demic of 1849 in New York, when cholera was 
allowed to exist from December to the early 
part of May without any attempt being made 
to put the city in as good sanitary condition 



22 Cholera. 

as possible and in consequence nearly 5,000 
deaths occurred, it is a brilliant illustration of 
the value of local hygienic measures. In 
1877-79 China and Japan suffered severely, 
and the excellent report we have of that epi- 
demic* makes very clear the necessity of 
promptly putting into execution the best 
measures for preventing the entrance of a dis- 
ease to a country. The reports of the last 
epidemic in Naples, as published in the 
"Medical News,"t furnish the same line of 
evidence. "August 2, 1884, the first case of 
cholera was reported in Naples, and the 
patient removed to the Conocchia Hospital, 
where he died. From that time the disease 
made gradual progress, of the course of which 
there was no official report, the fact of the 
existence of cases being published in a desul- 
tory way, no particular importance being 
attached to them, seemingly. They were said 
to have been sporadic and no fear was felt as 

* Op. Cit. f Medical News, Nov. i, 1S84 



Its History. 23 

to their spreading so late in the season. There 
were others who thought the disease was 
smothered for the time being, to break out with 
renewed force in May, 1885, when they ex- 
pected a gradual increase, followed by an out- 
break similar to that of 1836-37. 

The disease finally manifested itself in a de- 
cided manner on August 23. The former indif- 
ference of the authorities was changed to the 
greatest activity and anxiety; the portion of 
the city most exposed to the fury of the dis- 
ease was the Parto. It rapidly spread to the 
Mercato, Pendino, and Victoria, the former of 
which outstripped the Parto in the number of 
deaths, and has maintained the foremost posi- 
tion during the epidemic. On the 11th of Sep- 
tember the highest point was reached, the bul- 
letin of that day giving 949 fresh cases and 357 
deaths; this was followed by 843 fresh cases 
and 386 deaths on the 12th, 698 cases and 281 
deaths on the 13th, from which date there was 
a gradual decrease in both cases and deaths. 
On September 22 the cases had fallen to 305 

3 



24 Choleea. 

and the deaths to 97 within a period of twen- 
ty-four hours. 

The eyes of King Humbert and his ministers 
have been opened, as they never were before, 
to the true state of affairs among the poor of 
Naples, and the result may be the opening out 
of new streets through the four sections into 
which the fresh air of the bay and the purify- 
ing rays of the sun may enter freely; and a 
further result, a new system of drainage, not 
only for these sections, but for the remaining 
eight. ' ' It has been well said that efficient quar- 
antine does protect, but after the germs are once 
introduced no quarantine regulations will serve 
— nothing then but local hygienic measures will 
suffice. Neglect to take precautions cost Japan 
in 1877-78 many valuable lives and produced 
much serious disaster. In view of the fact that 
the past year has seen the dread disease attack- 
ing one place after another on the Continent, 
the question becomes an important one: What 
are we doing as a government to protect our- 
selves from its ravages? Objections are made 



Its History. 25 

by some to any inspection of ships coming from 
infected ports, just as they are made by others 
to the inspection of buildings and yards. There 
is almost without exception a disbelief in the 
local existence of a case of Asiatic cholera. 
Why persons should be so skeptical as regards 
the existence of individual casas of this disease 
and the danger from them is inexplicable on 
any other ground than that of self-interest. 
There are persons who are so skeptical as to 
distrust not only external testimony, but the 
evidences of their own senses, it is true; but 
the fear that trade will be interfered with and 
business decreased if the public mind becomes 
pre-occupied with the idea of danger from an 
epidemic, leads many men to treat the matter 
with culpable skepticism. These are the ones 
who present manifold obstacles to the prosecu- 
tion of any measures looking toward the pre- 
vention of disease; fthey are found on every 
hand — in our halls of legislation, obstructing 
the passage of bills for the appropriation of 
money; as members of committees to wait upon 



26 Cholera. 

officials and argue against just sanitary legisla- 
tion; as members of social and business circles, 
endeavoring to divert individual minds from 
the contemplation of facts which would tend 
to kindle a public sentiment in favor of hygi- 
enic measures. We find them on school boards, 
refusing to vote for appropriations for heating, 
ventilating, and draining the school-houses. 
We find them as property owners, neglecting 
to put their buildings into such conditions as 
will render the occupants safe from zymotic or 
other diseases. Thinking to protect their own 
interests, they work against the public weal, 
and thus do injury to themselves. The appear- 
ance of cholera the past year in Europe leads 
to the important question: Shall we have it in 
this country? The history, as we have seen, 
makes the answer, it is probable we shall. Men 
may call it sensationalism to agitate the mat- 
ter, but with the knowledge we have of former 
epidemics, and the danger attending neglect of 
thorough measures to prevent its ingress, it 
would be wrong not to make an endeavor to 



Its History. 27 

inform the people how they may protect them- 
selves from infection. Much has already been 
done by the general government and the vari- 
ous state and municipal authorities in the 
direction of a thorough quarantine and disin- 
fection of persons and goods arriving in this 
country from infected ports, but experience 
teaches that even the most vigorous quaran- 
tine does not prevent, now and then, a case 
getting in. What has actually been done in 
any city, town or village to meet such an 
emergency % Are there hospitals ready for the 
reception of patients % If one case occurs, it is 
the source from which there will arise many, 
unless active measures are adopted to prevent 
it. There is a disposition not to report such 
solitary first cases. Have the necessary 
arrangements been made for an inspecting 
corps? Are the details for disinfecting pro- 
vided for? Are the people thoroughly in- 
structed as to the measures they must adopt 
to render the spread of the disease impossible % 
Are the authorities of cities, towns and villages 



28 Choleea. 

taking active measures to cause the removal of 
all filth and disease-breeding material which is 
the favorite habitat of the cholera germ \ We 
say the authorities of towns and villages, be- 
cause facts prove that in many places there is 
much more carelessness in regard to drainage 
and the purity of water-supply in the rural 
districts than in cities. The experience of the 
residents in the little village of Plymouth, 
Penn., is an illustration of this. No attention 
was paid to the disposition of sewage; the 
water-supply was left to take care of itself. 
The number of cases of typhoid fever which 
resulted has now reached 905. A warning 
sounds with clarion voice to every town and 
hamlet, large and small, and it behooves the 
inhabitants, one and all, as well as the authori- 
ties, to attend to these matters. The author 
does not wish to seem an alarmist, neither 
does he desire to appear sensational. The 
foregoing questions are simply those which 
occur to every one who considers carefully the 
present condition of affairs. These are impor- 



Its History. 29 

tant matters, and if not already attended to, 
ought at once to be looked after. One of the 
great difficulties in any epidemic is the panic 
that comes upon the people; every one thinks 
something ought to be done and nobody knows 
just what to do; to be forearmed is to be cool 
and collected when the time for action comes. 
As an illustration of how a panic may be 
produced, we have only to turn to the record 
of the epidemic in Quebec in 1832. " On the 
11th of June of that year it was publicly 
announced that the malignant, or Asiatic chol- 
era had appeared at Quebec. On the 12th of 
the same month, the Board of Health of Mon- 
treal stated that there was no case of malignant 
cholera, although several patients had died of 
the common cholera of the country. On the 
18th, only six days later, we find reported 
2,516 cases and 437 deaths, but even this was 
thought at the time to be below the true esti- 
mate; the panic was so great that it was impos- 
sible to keep any accurate account of the 
numbers that sickened or died."* 

* Epidemic Cholera — Coventry. 



30 Cholera. 

When the accounts of the panic which pre- 
vailed in the epidemics of 1832 and 1849 are 
reviewed, the almost brutal interment of the 
dead and the desertion of friendsTnoted, the 
prevention of a repetition of such scenes is 
devoutly to be wished. There are no measures 
for preventing a panic more effective than the 
dissemination of such knowledge as will cause 
individuals to feel that they can, and have, 
put their persons and premises in such condi- 
tion as to prevent an attack. 



CHAPTER II. 

CHOLERA — ITS CAUSE. 

Just what factors are necessary to produce 
cholera as it appears in its home in the Delta 
of the Ganges is unknown; it is now believed 
to have been pretty conclusively proven that 
each of the various infectious diseases is due 
to a distinct specific causative agent, and that 
this agent is probably a living organism. For 
a long time this had been suspected; nearly 
half a century ago the statement was made 
that certain diseases had their origin in a fer- 
ment, and when Pasteur demonstrated that 
various ferments were micro-organisms, the 
supposition grew into a theory, and, under the 
investigations of Strauss, Roux, Virchow, 
Koch, and others, the theory has become an 



32 Cholera. 

established fact. The announcement by Koch 
that the germinal cause of cholera had been 
discovered by him caused, among scientists, 
an excitement in proportion to the interest 
centering in the disease at that time. It was 
on the 26th of July, 1884:, that he gave to his 
associates in Berlin the results of his investi- 
gations of the disease in Egypt, Calcutta and 
Toulon, and affirmed that a little organism 
shaped like a comma ( ,), so small as to be seen 
only with a high power under the microscope, 
was the essential cause of the terrible pesti- 
lence. Immediately other investigators took 
up the search, some confirming and others 
denying the statement. It is not at all to our 
purpose to follow the discussion of these sci- 
entists in detail, nor, indeed, even to indulge 
in any thing more than a brief sketch of some 
of the arguments in favor of the theory ad- 
vanced by Koch. He examined a large number 
of cases of cholera, and found in each the 
little comma-bacillus; he did not find the true 
comma-bacillus in the healthy body, nor in 



Its Cause. 33 

cases of disease other than epidemic cholera. 
Two Swiss physicians, Eietsch and Nicati, in 
the laboratory of the Pharo Hospital, at Mar- 
seilles, successfully inoculated a number of 
guinea-pigs, dogs and rats with cholera mi- 
crobes, and within two days the guinea-pigs 
died, after having exhibited the symptoms of 
cholera as seen in human beings; the dogs died 
in about four days after inoculation, having 
exhibited the same symptoms. Koch himself 
afterward confirmed this experiment. This 
was a crucial test, and seemed to furnish 
conclusive proof that the comma-bacillus 
bore a causative relation to cholera. These 
experiments are in a line with those to which 
Bernard refers in his "Introduction to the 
Study of Experimental Medicine," when he 
says, "The experiments on animals with dele- 
terious or noxious substances are very useful 
and perfectly conclusive for the toxicology 
and hygiene of man," but to which the anti- 
vivisectionists so strenuously object, Let us 
see what conclusions these men drew from 



34 Cholera. 

their work. "There is a practical mode of 
diagnosis in all doubtful cases of cholera; in 
such cases it would be sufficient to repeat with 
the contents of the patient's intestine the 
direct inoculation into the duodenum of the 
guinea-pig to ascertain whether it was a case 
of cholera or not. The second conclusion 
which they drew was a prophylactic one, viz., 
that the gastric juice and the bile digest the 
microbes very thoroughly. These two juices 
are excreted in large quantities during the 
digestion which follows a meal, so that impure 
water would be less dangerous when taken 
with food than when drunk by itself."* Do 
not these conclusions warrant the means em- 
ployed \ If true, the experiments upon which 
they are based may be made to relieve great 
anxiety or protect from much disaster. The 
life of a human being is of more value than 
many guinea-pigs. But to return from our 
digression; while in India, Koch found a water 
tank the water in which contained an abundant 

* Dr. Austin Flint, Sr., reported in Med. News. 



Its Cause. 35 

supply of the comma-bacillus, and when an 
outbreak of cholera occurred it was found that 
the inhabitants had been, and were, using the 
water; when the microbe disappeared from the 
water the disease abated, and in the places 
where the disease did not exist he did not find 
any comma-bacillus. These are, in substance, 
the facts as published in the "London Lancet " 
for September 20, 1884. They seem to prove 
that the comma-bacillus is the essential cause 
of cholera; there is need of confirmation by 
further experiments before they can take their 
place among indisputable conclusions, but 
they are pretty generally regarded as an ex- 
planation of the origin of cholera in places 
outside of the locality in which the disease is 
said to have its home. The older writers on 
cholera speak of the specific cause as being "a 
peculiar epidemic influence," and say that 
various circumstances increase the suscepti- 
bility of the system to this influence; that 
others hasten the attack, and still others call 
into operation a latent tendency to it, and so 



36 Cholera. 

cause its development. However this may be, 
there certainly are conditions which serve to 
develop the disease in localities and individuals, 
as we shall see when we come to consider some 
of the assisting causes and review some of the 
measures for its prevention. The theory of an 
epidemic influence seems to find corroboration, 
in the opinion of some, in many of the circum- 
stances occurring during a season of cholera 
visitation. One of these is that a number of 
cases of some particular disease occur just pre- 
vious to an outbreak of cholera; another, that 
so many are stricken down at the same time in 
different places who apparently have had no 
communication with each other, nor with any 
infected district; still another, that ships sail- 
ing upon the ocean have suddenly developed 
on board cases of the disease. As regards the 
first, it is not well proven; it is a fact that 
during an epidemic of cholera there are numer- 
ous cases of intestinal disturbance, but these 
may be accounted for on the supposition that 
an advanced guard, so to speak, of the epi- 



Its Cause. 37 

demic gains an entrance to the body, but, not 
finding there the conditions under which it 
thrives, serves only as a slight irritant and 
then passes away; in regard to the second and 
third, the germ theory of disease accounts for 
them much more satisfactorily than any other. 
There are certain well-established facts in con- 
nection with the epidemics that have occurred 
heretofore which substantiate these assertions. 
First, it has frequently been observed that the 
dejecta from persons suffering with simple 
intestinal flux have produced cholera: second, 
as has already been mentioned, it, in the ma- 
jority of cases, starts from India, although Dr. 
Elisha Harris says: " Cholera has prevailed 
extensively in the United States during eight 
out of the forty-one years since its first appear- 
ance on this continent. But in only four out 
of the eight years, as we have reason to con- 
clude, was this pestilence freshly introduced 
into the United States from Europe. The new 
importations of the exotic germinal cause were 
abundantly witnessed in the years 1832, 1848- 



38 Cholera. 

49, 1854, 1865-66."* It follows the lines of 
travel pursued by armies, caravans, pilgrims 
and transports through and over the water- 
ways of Europe. It moves with the merchant 
marine to this continent, where we can trace it 
over all our routes of travel, along the canals, 
railroads, rivers, lakes, across the plains; every- 
where man goes, it goes. Man is the chief car- 
rier of the disease. We notice, too, from the 
history, that it extends most rapidly where 
there is the greatest aggregation of men, and 
that among the class of people with whom 
squalor is a constant condition, whose houses 
are dirty, whose persons are unclean, and 
whose surroundings are filthy, the disease runs 
riot during an epidemic. These circumstances 
lead to the conclusion that there is a specific 
cause and man is the chosen vehicle for the 
transmission of that cause. We observe, too, 
that in a city attacked by the disease there is 
sometimes a distinct line drawn between the 
infected and the uninfected district; one side 

* Report to Am. Pub. Health Ass'n by Dr. E. Harris, 1874. 






Its Cause. 39 



of a street will be affected, the other will 
escape; the upper story of a house will be free, 
while the lower may have two or more cases, 
which would tend to prove that the cause is 
not an epidemic influence, but a distinct germ, 
which, finding in certain restricted localities 
the necessary conditions for its growth, devel- 
ops into virulence. We have seen that in 
Mecca when the city was crowded with pilgrims 
who drank of water made foul by centuries of 
'unsanitary practices, and polluted by them- 
selves, there was a terrible re- enforcement of 
the disease. Similar occurrences took place in 
India, China and Japan before the systems of 
sewerage now in operation were completed, 
and with the removal, by this new sewerage 
system, of the contaminating material from the 
water supply, the violence of the epidemics has 
been very much diminished. When we con- 
sider that in these places, with the exception 
perhaps of a portion of India, cholera does not 
exist all the time, but the water is drunk con- 
stantly, the question at once arises : Why is 

4 



40 Cholera. 

this so ? For answer we look to the reports of 
Commissions appointed by several governments 
to investigate this very point, and we find that 
in probably every case the disease was brought 
by some person or persons coming from an 
infected district, and the germs of this disease 
gaining entrance to this polluted water, found 
there the very best conditions for their rapid 
development. Enough has been said to indi- 
cate the reasons why cholera is supposed to 
have its origin in an organism. That the 
comma-bacillus is this organism is stoutly 
denied by many investigators, and the reasons 
given for this opinion are certainly entitled to 
consideration. Some of these men admit that 
the comma-bacillus, while in and of itself 
harmless, yet does excrete a virus, under cer- 
tain conditions, which produces cholera; but, 
as has already been said, it is not our purpose 
to follow all the arguments pro and con; those 
who desire to do so can find them fully set 
forth in the reports of the various cholera com- 
missions, as published for the several Boards 
of Health. 



CHAPTER III. 

CHOLERA — ITS PROPAGATION. 

The fact admitted that the origin of cholera 
is a germ, it will be profitable for us to con- 
sider, before studying measures for the pre- 
vention of an epidemic, some of the assisting 
causes, or, in other words, some of the means 
by which the germ is propagated when once 
introduced. It is a self-evident proposition 
that to keep it out is the best thing to do, but 
this cannot always be done, and if those con- 
ditions which aid its development are under- 
stood, preventive measures will be plainly indi- 
cated. There are those who denounce quar- 
antine as barbarous and, at best, ineffectual, 
and consequently useless. While there are 
many objectionable features connected with 



42 Cholera. 

systems of quarantine, instances are not want- 
ing which demonstrate its value and show the 
evil result of its abandonment. When Den- 
mark, which had been frequently exposed to 
the danger of cholera infection from other 
nations, but had always escaped through the 
strict quarantine she maintained, for the first 
time removed this, an epidemic occurred in 
the country, in which there were 7,000 cases 
with 4,000 deaths. The quarantine was then 
re-established, and there has been no more 
cholera there up to the present time. The 
same thing was true in regard to Greece. Al- 
though quarantine may not be competent to 
prevent the ingress of every case of infectious 
disease, it is a safeguard of inestimable value 
at ports of entry, and its maintenance in an 
efficient manner is a matter upon which inland 
towns, especially those situated upon the great 
water-ways and routes of travel, have a right 
to express an "opinion, and a right, also, to 
expect that their opinion will be regarded. 
Among the assisting causes of cholera, we may 



Its Propagation. 



43 



mention, first, that of fear. It is well known 
that there is no moral influence which produces 
so depressing an effect on the system as fear. 
It has been clearly proved that the most vigor- 
ous of men, even in the most perfect health, 
may be frightened to death. Instances were 
not wanting during the war of the Rebellion 
where soldiers were so overcome by fear from 
an impending battle as to be thrown into a vio- 
lent intestinal flux, which rapidly reduced 
them. If we only look at a frightened person, 
we see that he presents almost the first symp- 
toms of cholera; the blood retreats from the 
surface to the central organs of the body, leav- 
ing the face pale, the hands cold, and the pulse 
feeble; indulged in to any extent, it reduces 
the resisting power of the system, and the per- 
son falls a victim to a disease which might not 
have attacked him at all, or have proved so 
light as to have produced no serious conse- 
quences. Furthermore, it interferes with the 
discharge of those duties upon the faithful 
discharge of which the safety of the person, 



44 Cholera. 

and perhaps the household, depends. It serves 
also to spread the disease; a person dreads an 
attack, and, to avoid it, leaves the place where 
the epidemic is prevailing ; with him go the 
germs of the disease, they find lodgement in the 
material favorable for their development, and 
in a little time cholera appears in that place. 
An illustration of this is found in a case occur- 
ring in the little village of Omergues, in France. 
The place is a small, closely built mountain 
hamlet, where few ideas of cleanliness or sani- 
tary prudence prevail. A servant in Marseilles 
left her employer and went to her home in this 
little village, taking with her the fatal germ. 
She and two of her family died, a panic seized 
upon the little community, and before the dis- 
ease could be checked twenty-five of the inhabi- 
tants had died. Another assisting cause is 
found in impaired health. This term is made 
to include every condition that tends to weaken 
the vital energies, whether it be exhaustion 
from overexertion, either physical or mental; 
want of sufficient nourishment; derangement 



Its Propagation. 45 

of the digestive organs by excesses in eating or 
drinking; debility from exposure or excesses 
of any kind; the existence of any constitu- 
tional disease or the convalescence from sick- 
ness; by reducing the vital power they bring 
the system within the influence of the epidemic 
cause. Bad drainage is one of the chief allies 
of cholera. In cities it acts to pollute the 
atmosphere of dwellings, and, when accom- 
panied by poor ventilation, surcharges the air 
with noxious gases, and the vital functions are 
so materially interfered with as to produce a 
condition of the system which renders it very 
susceptible to the epidemic cause of the disease. 
In the country it leads to the deposition upon 
the surface of the ground of a mass of decaying 
matter, which serves as a breeding place for 
the cholera germ and causes the pollution of 
wells, cisterns and other sources of water sup- 
ply. In many places the drain is nothing more 
than a ditch, in which lies a mass of putrefying 
matter exposed to the rays of the sun and 
exhaling poison along its whole length; in 



46 Choleea. 

other cases it is covered, but having been con- 
structed of wood, this decays and permits the 
contents of the drain to escape and filter 
through the soil into the cellar or well. This 
leads directly to the consideration of another 
assisting cause, and that is filth. Decaying 
vegetable and animal matter in or around a 
dwelling is in violation of one of the oldest 
and most important sanitary principles. Such 
material, if not the breeder, is a harborer of 
the germs of very many diseases, and of none 
more so than of cholera. In the history of 
every epidemic we find those places low-lying, 
damp and dirty invariably attacked. The dis- 
ease is not always confined to them, it is true, 
for causes may be operative to make it appear in 
places scrupulously clean, but places abound- 
ing in filth are never exempt. The lower por- 
tions of large cities, where the streets are nar- 
row and buildings high, so that the sun can 
never reach them, where all the refuse from 
the houses, it would seem, is thrown into the 
roadway, creating such a stench that one almost 



Its Propagation. 47 

fears to breathe while passing through, where 
women and children vie with each other in 
seeing which can present the most wretched 
appearance, where the homes (?) are the acme 
of filth and misery; these portions are the first 
to be attacked in an epidemic, and the foci 
from which radiate thousands of disease germs. 
Filth is not confined to these portions of the 
town, however; oftentimes in what would be 
called well-regulated families there are found 
vessels filled with decaying garbage, stationary 
tubs half filled with dirty wash- water, areas in 
which lie rotting and rusting all sorts of things, 
the accumulation of months; cellars in the dark 
corners of which are vegetables long since 
dead; streets, alleys and yards in such condi- 
tions of neglect that the only wonder is that 
any one can be well. The cholera persistently 
hunts out such places, and lurks there until it 
has gathered strength sufficient to attack and 
destroy whole families. In many places in the 
country the filthy habit prevails of emptying 
all the refuse from the kitchen, wash-water, 



48 Cholera. 

and chamber vessels upon the ground just out- 
side the house, and for the space of three or 
four yards square the ground is sodden and 
slimy. Until the people can be made to change 
this condition of affairs, zymotic diseases will 
flourish and epidemics will find plenty of food. 
The most powerful of all the causes which 
assist in propagating cholera is drinking water 
polluted in some way. We have seen that in 
Egypt and India pilgrims use for drinking the 
same water they have used for bathing and 
washing their clothing, and we have seen how 
terribly they suffered with cholera. There is 
abundant evidence, amounting almost to a 
demonstration, that polluted drinking water 
plays the most important part in disseminating 
cholera. John Marshall, of the University 
College, England, has furnished, in a commit- 
tee report, the most convincing evidence of this; 
(this is the celebrated Broadstreet pump case). 
" In Rotterdam, during an epidemic of cholera, 
the introductioD of pure water immediately 
reduced the mortality to one-half. Dr. Auc- 



Its Pkopagation. 49 

land relates, as quoted by Dr. Parkes, that two 
jails were near each other; the inmates of the 
one suffered, those of the other did not; the 
water was impure in the one case from drain- 
age, pure in the other. The jail with bad water 
having got a fresh supply, the cholera did not 
appear there in the next epidemic. In Haar- 
lem, Holland, cholera prevailed with great 
intensity in 1849. In 1866 it returned and 
again prevailed as severely in all parts of the 
town, except one; that part entirely exempted 
in the second epidemic was inhabited by bleach- 
ers, who, between 1849 and 1866, had obtained 
a fresh source of pure water. 

"Prof. Foerster has shown that five towns 
of Silesia (of 5,000 to 12,000 inhabitants) are 
entirely free from cholera, which never spreads, 
even when introduced. The only common con- 
dition is a water supply which cannot be con- 
taminated. In Glogan half the water is from 
a distance and half from wells; those using the 
former remain free; those using the latter are 
attacked. Dantzic and Konigsberg formerly 



50 Cholera. 

suffered equally; Dantzic having a new water 
supply, does not suffer; Konigsberg, with its 
original supply, continues to suffer. In Berlin, 
in 1866, cholera prevailed much more in the 
houses supplied with bad water than in houses 
su pplied with good water. ' ' * We have already 
mentioned that in India the introduction of 
a sewerage system relieved the water supply 
of much impurity, and in consequence the 
violence of epidemics is very materially dimin- 
ished. Impure drinking water is obtained in 
many of our cities, from several sources. 
Wells located in thickly populated districts 
receive more or less of the surface drainage 
from filthy streets, and much of the water in 
them comes through soil saturated with pollu- 
tion of various kinds; it is said that in the city 
of St. Louis there are 7,000 such wells sunk in 
the various streets, alleys, courts and yards of 
tenement and other houses, and surrounded by 
vaults, stables, cesspools and sewers; in other 
cities the same is true, though not perhaps to 

* Maxims of Public Health— O. W. Wight, M. D. 



Its Pkopagation. 51 

so great an extent. Elvers and streams, the 
banks of which are thickly studded with vil- 
lages, towns, populous cities, manufacturing, 
dyeing and cleansing, and refining establish- 
ments, are taken for the source of a water sup- 
ply; the filthy stuff flowing in them is pumped 
into reservoirs, distributed throughout a city, 
and the inhabitants compelled not only to 
drink it, but to pay a good round sum for the 
privilege (?) of risking poisonous infection with 
every draught they imbibe. The citizens are 
told by those in whose power they are that 
water contaminated by the sewage of a city of 
50,000 inhabitants will purify itself in a flow of 
a very few miles, whereas instances without 
number are on record that such is not the case. 
We will not occupy space to cite cases, but w T e 
cannot prevent the mind of the reader reverting 
to the fatal epidemic of typhoid fever, not yet 
over, in Plymouth, Penn., where upwards of 
900 persons have suffered from the effects pro- 
duced by the dejecta of one person having been 
introduced to the source of water supply at a 



52 Cholera. 

distance of several miles above its point of dis- 
tribution. Such evidence points out the dan- 
ger at all times lying in the use of water for 
drinking purposes which comes from a source 
liable to pollution. At the present time it has 
an added significance; not that foul water will, 
per se, produce cholera ; no amount of bad 
water will do that ; the germ must be im- 
planted. Fear, poor health, bad drainage, 
want, squalor, filthy surroundings — none of 
these things will produce cholera, but the dis- 
ease flourishes amid such surroundings. No 
soil, however rich, will produce a crop if the 
seed be wanting, of which proposition the con- 
verse is also true — no seed will produce a crop if 
the soil is not good. To gather up, then, the re- 
flections in this chapter, we may say that the 
present position of the best authorities, which 
meets facts as observed, and may be accepted 
as correct, is as follows : Cholera is the result 
of the development of a germ; it is conveyed 
by individuals chiefly, and by the articles 
soiled by the dejecta of cholera-infected per- 



Its Pkopagation. 53 

sons; "its poison is contained in, and propa- 
gated by, the discharges from the bowels of 
those infected, which, finding access to drink- 
ing water, or resting upon food, gains entrance 
to the digestive tract of others. It is not cer- 
tain that in a heavily charged atmosphere the 
poison may not be swallowed with the air, but 
the infection mnst take place through the ali- 
mentary canal, and in this very limited sense 
alone can cholera be spoken of as i contagious,' 
thus probably resembling typhoid fever. In 
other words, an individual who could avoid 
swallowing the poison, might safely associate 
with cholera patients, and the digestive func- 
tions being quite healthy, he would probably 
escape, even if he swallowed a moderate dose."* 

* Boston Medical and Surgical Journal. 



\ 



CHAPTER IV. 

CHOLERA — ITS PREVENTION. 

The means by which cholera may be pre- 
vented have already been indicated by the 
explanation of its cause and the description of 
the ways in which it is diffused. Its habits, 
and the factors in its cause and spread, being 
so well understood, we are warranted in be- 
lieving that this pestilential destroyer may be 
successfully resisted, and its material means 
of propagation be completely controlled. Sci- 
entists may differ as to the exact form of its 
specific germ, physicians may vary in their 
opinions as to some of the facts concerning the 
various forms of the epidemic and the most 
effective treatment, but upon the essential 
points— sanitary measures as preventive means 



Its Prevention. 55 

— there is as much, certainty as there is upon 
similar facts in the causation and prevention of 
any other epidemic disease. The fact that in 
Bombay, Madras, Calcutta and other places 
where, in former times, the disease made such 
terrible havoc, methods have been adopted by 
which the pestilence is shorn of half its terrors, 
indicates very clearly that similar methods 
pursued in a country where the disease is only 
epidemic, where it does not naturally grow, 
would be efficient to destroy it altogether. 
"When considering the causes of cholera, we 
took occasion briefly to allude to some views 
upon the subject of quarantine, and will, at 
this time, only add that in the enforcement of 
strict quarantine regulations it is possible, 
unless great consideration is shown, to work 
much injury to those whose persons or goods 
are subjected to them; furthermore, there is 
apt to be so much reliance placed upon such 
regulations as to lead to carelessness on the 
part of those presumed to be protected by them, 
sanitary precautions are neglected, and they 

5 



56 Cholera. 

are rudely awakened from their dream of fan- 
cied security to find the visitor upon them and 
their house not ready to receive him. The 
fact that cholera is transmissible is beyond 
question; so also is the fact that it does not 
fatally attack all the individuals exposed to its 
influence. A well-regulated life and good 
hygienic conditions are almost certain guaran- 
ties against its action; it rages by preference in 
unhealthy localities, among populations weak- 
ened by misery and among individuals whose 
powers of resistance are undermined by disease 
or excess. All these circumstances are, to a 
large extent, under the control of individuals, 
and, in so far as they are, it is for each one to 
decide for himself whether or not he will be 
attacked by the disease. We have seen it is 
not contagious, in the wide sense of the word, 
and so there is no need for that morbid fear 
which only renders its subject the more liable 
to be attacked; if, however, there shall be a 
wholesome dread which will lead to the en- 
forcement of strict sanitary rules in every 



Its Pkevention. 57 

household, much good will be accomplished. 
Observation has shown that cholera is a pesti- 
lence which is nourished in a locality where 
there is stagnant water and marshy ground, 
and that such places when visited by it become 
foci for the further distribution of it. It be- 
comes, then, a matter of the highest impor- 
tance that such places be reclaimed from their 
unsanitary conditions. An hour' s ride through 
almost any city will bring to view large areas 
covered with stagnant water or reeking with the 
decomposition of material left after the water 
has evaporated. The local boards of health en- 
deavor to reclaim such places, but frequently 
they are met by the most violent opposition 
from those who should be foremost in promot- 
ing the public welfare. It is the duty of the 
authorities to co-operate with the board of 
health in these matters and to see that such 
places are put in a safe condition; if the doing 
so works an injury to individuals, liberal ap- 
propriation should be made to compensate for 
such injury. Landlords and owners of houses 



58 Choleea. 

in towns and cities should see to it that the 
drains in their houses are in proper condition, 
so that the atmosphere may not be contami- 
nated with emanations from sewers, sinks and 
cesspools. Occupants of houses should make 
sure that there is nothing in or around the 
house, in cellars, areas, back-yards, alleys or 
out-buildings, which, by its decomposition, 
shall pollute the air. The rich suffer equally 
with the poor when surrounded with a pol- 
luted atmosphere, so that it becomes a matter 
of general concern. In the country, out-houses, 
pig-pens and chicken-houses should be kept 
clean and privy vaults disinfected daily. A 
foul air, at all times, undermines health, but 
when an epidemic comes it renders the mor- 
tality very much greater than it otherwise 
would be. The medical officer of the Privy 
Council of England, as quoted by the late Dr. 
Harris in his report already referred to, says : 
"The specific migrating power of cholera, 
whatever its nature, has the faculty of infect- 
ing districts, in a manner detrimental to life, 



Its Prevention. 59 

only when the atmosphere is fraught with cer- 
tain products susceptible, under its influence, 
of undergoing poisonous transformations. 
Through the unpolluted atmosphere of cleanly 
districts it migrates without a blow. That 
which it can kindle into poison is not there. "* 
" There is a small colony of Moravians at a 
place called Sarepta, situated in the bend of 
the river, which has been noted by travelers 
for its neatness and industry. Dr. Verollot 
says the cholera itself seems to respect this 
sacred spot, passing by both in 1830 and 1847 
without inflicting on it the least injury." The 
sanitary condition of the place is the most 
important thing to be attended to. Local 
boards of health can do much of this, but not 
all; the citizens themselves must be willing to 
co-operate with them. There ought to be a 
strong public sentiment in regard to the mat- 
ter, so that when a question of sanitation 
comes up for consideration it will have the 
attention and support of the public; if this was 

* Conclusions Concerning Cholera — Elisha Harris, M. D. 



60 Cholera. 

the case, there would be much less cause for 
complaint that unsanitary conditions remain 
unremedied. Too often the people, as well as 
the authorities, when notified of such evils by- 
health officers, receive the information with an 
indifference and apathy, if not a spirit of oppo- 
sition, that is quite discouraging. We expect 
some opposition from the poorer classes and 
the uninformed whenever the enforcement of 
sanitary rules, such as vaccination, isolation, 
disinfection, drainage or ventilation, is at- 
tempted, but from the better class it ought not 
to be so. With more effort on the part of 
those who know and realize the importance of 
these matters, information might be furnished 
that would prevent all annoyance. The intro- 
duction of the study of hygiene, the laws of 
health and the elementary principles of sani- 
tary science into our public schools; a sermon 
preached once in a while upon the subject by 
clergymen, especially those having the spiritual 
oversight of congregations composed largely of 
a class of people who, if appearances are any 



Its Prevention. 61 

indication, are either wofully ignorant or else 
care but very little for personal cleanliness or 
the purity of their surroundings, would ma- 
terially assist in this result. Certainly the 
bearing of this subject may be shown to be 
very direct upon those higher principles which 
clergymen are selected to teach and exemplify. 
A law enacted which would be something more 
than a "dummy," whereby persons could be 
punished for not exercising the proper care in 
such matters, or the execution of such laws as 
already exist, would furnish some wholesome 
examples, now and then, by way of a reminder 
to the willfully negligent. Judge Dixon, of 
New Jersey, in a recent charge to the grand 
jury at Paterson, said: "If a man, conscious 
that he carries about with him the germs of a 
contagious disease, recklessly exposes the 
health and lives of others, he is a public nui- 
sance and a criminal, and may be held answera- 
ble for the results of his conduct. If death 
occurs through his recklessness, he may be 
indicted for manslaughter. The man may be 



: 



62 Cholera. 

indicted also for spreading the disease by con- 
scious exposure of others thereto, by his pres- 
ence in public places, such as on the streets, 
in halls, etc. He might be indicted for endan- 
gering the public health in this way, even if 
no consequences had followed. The law pro- 
vides some penalty for such olfenses against 
the public safety."* The man who maintains 
a nuisance is amenable to the law if he does 
not abate it when notified to do so, because he 
endangers the public safety. The man who 
maintains his premises in an unsanitary condi- 
tion endangers the public safety equally with 
those mentioned, and ought to be punished as 
well. The prominent part an impure water 
supply plays in the spread of cholera has been 
dwelt upon at some length in the chapter on 
"Propagation," audits importance requires 
that emphasis should here be laid upon its re- 
moval. Impure drinking water not only serves 
as the medium for the transmission of the 
cholera germ during an epidemic, but it ever 

* Medico-Legal Journal. 



Its Prevention. 63 

threatens the health and life of the persons 
using it. Wells in localities rendering the pol- 
lution of their waters probable should be so 
strictly guarded, and if need be closed, as to 
render it impossible for persons to obtain water 
from them for drinking purposes, and boards 
of water commissioners ought to be compelled, 
if necessary, to protect the sources of their 
water supply from pollution. This would be 
impossible in the case of a supply taken from 
large rivers or from streams upon whose banks 
there is either much population or manufac- 
turing establishments. These are inevitable 
sources of pollution, the possibility of remov- 
ing which not existing, such sources should 
not be taken for a water supply. 

Thus far we have considered preventive or 
precautionary measures as relating to localities 
not already attacked by an epidemic disease. 
We have seen that thorough systems of drain- 
age and sewerage, removal of filth and offal of 
every kind, good pure air and wholesome 
water, will do very much towards protecting a 



64 Choleea. 

community from an attack, but all these pre- 
cautions may fail to prevent some cases gaining 
access to a city or town. It will be well, there- 
fore, to review some of the measures necessary 
to prevent the spread of cholera, should cases 
of the disease actually present themselves. 
One of the most important of these is personal 
hygiene. Cleanliness of person and clothing — 
the free use of soap and water — has been the 
means of saving the health of many a person. 
What has been said of clean streets, clean air 
and clean water is just as true of clean persons; 
the cholera germ abhors them. Moderation in 
eating and drinking is also important, for, as 
we have seen, it is possible for the fluid of a 
healthy stomach to digest, and so destroy, the 
virus of cholera; not so with that of a stomach 
wearied with the labor necessary to dispose of 
an inordinate amount or variety of food, or 
wrought up almost to a condition of mutiny by 
floods of alcoholic or brewed liquor having 
been poured into it. As when a person is 
fatigued to excess by mental or physical toil 



Its Pkevention. 65 

he readily succumbs to the malign influence 
producing pneumonia, so when the digestive 
organs are overtaxed the alimentary canal is 
in poor condition to resist the invasion of the 
cholera germ. Plain, wholesome, nutritious 
food, in sufficient quantity, with no excess in 
the use of tobacco and liquor, fortify t^e sys- 
tem under almost all conditions; in times, how- 
ever, when cholera is present in a place, some 
extra precautions will be needful. Heat de- 
stroys the cholera germ; hence no food should 
be partaken of unless thoroughly cooked. 
Such articles as cannot be subjected to this 
process should, in a season of cholera visita- 
tion, be dispensed with. This does not apply 
to such vegetables and fruits as can be peeled 
or pared; these articles having been cleansed 
and the rind removed, may be eaten, provided 
they are fresh and ripe, and not over-ripe. 
The reason why fruit oftentimes provokes dis- 
turbance when eaten is because it is either 
unripe, over-ripe, or because it has been kept 
so long as to have allowed the process of decay 



66 Cholera. 

to begin. The possibility of the transmission of 
infectious and epidemic diseases through the 
agency of cow' s milk is established beyond a 
question. Nearly fifteen years ago an epidemic 
of typhoid fever raged in a little town, and 
most careful investigation was made to dis- 
cover, if possible, the cause of it; finally sus- 
picion pointed to the milk supply, and it was 
the pronounced opinion that the virus was dis- 
seminated through that medium. Since then 
much attention has been given to this source 
of transmission, and a large number of epidem- 
ics have been traced indubitably to milk which 
had in some way become contaminated by the 
virus of an infectious disease. " Dr. Thurs- 
field, an English Medical officer of health, who 
has investigated the subject of milk epidemics 
very carefully, proposes certain precautions 
which he considers effectual in preventing 
these outbreaks of disease. The responsibility 
is divided between the consumer and the sani- 
tary authorities. He urges upon the consumer 
the precaution of boiling all milk. There is a 



Its Prevention. 67 

prejudice against this practice, but it ought to 
give way if it be true that ' to boil milk may, 
for practical purposes, be said to confer immu- 
nity from infection conveyed by it.' The milk 
shop of the retailer and the dairy of the whole- 
sale purveyor should be placed under the 
strict control of the sanitary authorities, which 
should be clothed with power to make proper 
regulations and to enforce them by the aid of 
efficient inspectors."* Just how the milk be- 
comes infected it may be difficult to say in 
every case; the vessels in which it is contained 
may become contaminated, or the water with 
which it is sometimes adulterated may be the 
bearer of the specific germ; but that it is, at 
times, a medium for the dissemination of 
disease germs, is beyond question. And yet 
it is impossible to detect the virus in 
most cases by any form of investigation or 
analysis; hence the force of the remarks just 
quoted. There should be strict sanitary care 
(and official inspection if necessary) of all 

* Med. News, Nov. 29, 1884. 






68 Cholera. 

dairies and milk shops, and the milk should 
be boiled before being used by the consumer. 
What has been said in regard to milk is pre- 
eminently true in regard to water. No water 
should be used for drinking or culinary pur- 
poses that has not been boiled and carefully 
protected from the air. By the process of 
boiling, the germ, if the water contains any, 
is killed; but if the water is then left to cool in 
open vessels it is liable to re-contamination; 
it should therefore be bottled before being put 
away to cool. Boiling not only kills the dis- 
ease germ, but it u kills" the water too. Any 
one who has tasted boiled water knows how 
insipid it is. This flatness may be removed to 
some extent in several ways; a few tea leaves 
may be put into each bottle just before the 
boiling water is put in; this will not make tea 
in the ordinary sense of the word, but it will 
materially relieve the insipidity. A little 
lemon juice added to the water improves the 
taste very much, and also serves the purpose 
of supplying to the system a very useful sub- 



Its Prevention. 69 

stance in cholera times. It has been shown that 
the cholera germ can only live in an alkaline 
solution, that a neutral solution is unfavorable 
to its rapid development, and that a solution 
in which there is the least trace of an acid is 
fatal to it in a very short time. This would 
suggest the propriety of drinking lemonade 
and other acidulated drinks, in moderation. 
Great caution should be exercised in cholera 
times in the use of lettuce, chopped cabbage 
and other vegetables which it is customary to 
eat without cooking; the vinegar usually used 
with them serves somewhat as a protection, 
but should always be put on and allowed to 
stand for a few minutes before the oil, if any 
used, is put on. Care should be exercised, 
too, as regards the use of ice. While ice cut 
in the winter, preceding an epidemic, would 
not be likely to contain the germ, it neverthe- 
less may become the medium for its transmis- 
sion; it presents one condition favorable to its 
development, that is moisture. Freezing does 
not kill the germ, it only arrests its growth; 



70 Cholera. 

finding a lodgment on the ice, and so an 
entrance to the refrigerator, this microscopic 
fiend wonld be ready at the first opportunity 
to pass from the ice to the meat, vegetables, 
milk, or any other food that might be placed 
near it. The best modern refrigerators have a 
distinct compartment for the ice, entirely sep- 
arate from those in which the articles of food 
are kept; where such are used precaution is 
only necessary when the ice is taken from 
them, and put in the water, or on the butfcer, 
or in any other way is brought in contact with 
the food. It will be seen from the foregoing 
remarks that the main object to be kept in 
view is to prevent the cholera germ from enter- 
ing the alimentary canal. Dr. Simmons, refer- 
ence to whose report on the cholera epidemic 
in China and Japan has been made several 
times in the preceding pages, has passed 
through a number of cholera epidemics in 
Europe and Asia, and seems to fear the disease 
no more than chicken-pox. Neither he nor 
his attendants have ever suffered an attack, 



Its Prevention. 71 

and he attributes their immunity in very great 
measure to the adoption of such precautions as 
those already mentioned. That there may be 
still further safety provided, disinfection will 
necessarily be resorted to — disinfection of 
vaults, cesspools, sewers, drains, waste-pipes, 
water-closets, cellars and all parts of the house 
where possibly there might be material or 
place in which the disease germ could thrive. 
In case a person is attacked with the disease, 
thorough disinfection of the room, the material 
evacuated from the bowels, and the clothing 
soiled by these, or in any other way by the pa- 
tient, will be absolu tely essential. Of the various 
disinfectants we shall speak more particularly 
in another chapter. Cholera comes on insidi- 
ously and runs its course with great rapidity. 
In this disease the expression, " While there 
is life there is hope," is as true as in any 
other, but all authorities are agreed that the 
golden opportunity for curing the patient is 
during the preliminary diarrhoea. It is the 
more important to remember this, as the 

6 



72 Cholera. 

bowel trouble is attended with little or no 
pain; there is an inclination to go to the closet 
somewhat more frequently than usual, but, 
there being no pain — nothing but a slight feel- 
ing of weariness — suspicion is not aroused 
until the patient is suddenly prostrated; dis- 
charge follows discharge, vomiting sets in, 
violent cramps seize the poor victim, a death- 
like pallor overspreads the face and form, the 
eyes are surrounded by dark blue circles, a 
cold, clammy, but very profuse perspiration 
bathes the skin, the patient grows weaker and 
weaker, and soon enters the stage of collapse; 
even to this time the mind has remained per- 
fectly clear, but now its torch flickers and 
goes out as the spirit takes its flight from the 
tortured body. The disease is of too serious a 
nature, runs too rapid a course to warrant me 
in giving, in this place, any methods for home 
treatment; I shall offer in their place one or 
two cautionary suggestions. On the appear- 
ance of the slightest diarrhoea in a cholera 
season, see your family physician; do not wait 



Its Prevention. 73 

to take a little medicine, laxative or astringent, 
as yonr judgment may decide, thinking that 
on the morrow, if you are not better, you will 
see the doctor; remember the golden oppor- 
tunity is just at this time. Beware of adver- 
tised "Sure Cures for Cholera;" "there is 
death in the pot." Your trusted family physi- 
cian is the one to consult, and his prescription 
will be the safest for you to follow. Having 
thus briefly stated some of the more prominent 
facts in regard to cholera, we come now to con- 
sider a little more in detail some of the things 
which make for better health of communities 
and individuals. 



CHAPTER V. 

THE HYGIENE OF FOOD AND DRINK. 

When the preventable causes of disease are 
considered, especial attention mnst be paid to 
the purity and wholesomeness of those articles 
which constitute our daily food and drink, and 
this attention, which is at all times a duty, is 
more particularly demanded during seasons 
when sickness is unusually prevalent or epi- 
demics of specific diseases are anticipated. The 
possible introduction, ere long, of cholera into 
the United States, and the probable spread of 
the disease if introduced, renders it incumbent 
upon us to set our houses in order and to take 
more than ordinary precautions for the preser- 
vation of health. A few remarks, therefore, 
upon food and its adulterations and water and 



The Hygiene of Food and Deink. 75 

its impurities will probably be considered not 
out of place in this connection. 

Our foods, in the ordinary sense of the 
word, are derived from the animal and vege- 
table kingdoms exclusively. From the former 
we chiefly obtain those substances which 
build up our tissues and repair the constant 
waste of the body, and from the latter most 
largely those compounds which by their 
oxidation develop animal heat and force. 
Meat, since in some form it makes up a con- 
siderable portion of the diet of most adults 
and is most important as a tissue former, 
may well receive attention first. It is fortu- 
nately, as a rule, easy to obtain wholesome 
meat in most sections of this country. Fresh 
meat properly cooked is more digestible and 
nutritious than that which has been salted or 
smoked. If care be taken during hot weather 
that meat be not tainted from incipient putre- 
faction, no especial precautions need be exer- 
cised in the use of ordinary butcher's meat. 
Beef tea, as usually made, has little or no food 



76 Cholera. 

value, and is more of a stimulant than a nu- 
trient. The possible presence of trichinae in 
pork is to be borne in mind, and it should be 
remembered that salting or smoking does not 
necessarily destroy the parasite, but that a 
sufficiently high temperature does, so that no 
risk whatever attends the use of well-cooked 
pork in any form. Certain articles manufac- 
tured on a large scale from various odds and 
ends, like head-cheese and sausages, are often 
made from diseased, decayed or otherwise un- 
wholesome meat, and should be used with 
caution. A specific poison, the exact nature 
of which is not well understood, is sometimes 
developed in such foods which is capable of 
giving rise to the most distressing illness. Fish 
is, when fresh and not in too large quantity, a 
generally wholesome food, but if it has changed 
color or has an unpleasant odor, it is unfit for 
consumption. Many kinds of meat and fish 
are now put up in hermetically-sealed tins, and 
while a prejudice exists on the part of some 
against their use, this prejudice is not, in the 



The Hygiene of Food and Dkine:. 77 

main, well founded. Many cases of illness 
alleged to have resulted from the use of canned 
articles^ have been shown, on investigation, to 
have been due to other causes, and while un- 
wholesome meats may sometimes be packed, or 
small quantities of tin or lead may occasionally 
be discovered in the contents of the cans, we 
believe that the danger has been greatly over- 
rated, and that when the best brands are em- 
ployed there is practically as little risk in the 
use of tinned as of fresh fish, meats and vege- 
tables. Let it be remembered, however, that 
when a can is opened its contents should all be 
turned out, and that if part only is used the 
remainder should not be allowed to stand in the 
can, for in the presence of air metallic impreg- 
nation is doubtless likely to occur, especially 
in the case of easily fermentable and acidulous 
substances. 

Milk is a most valuable food, and largely 
consumed by the young. If pure, it contains 
all the substances essential to the support 
of life, but when robbed of its fat by the 



78 Cholera. 

removal of its cream or diluted by the addition 
of water, as too frequently is the case, it 
is not only much less nutritious, but it may 
also serve to propagate disease if an impure 
water has been added. Numerous cases of 
typhoid fever have been traced to the use 
of polluted water in adulterating milk, and 
it would be well if a much closer inspection of 
the milk sold in our cities could be made. 
Fortunately skimming and watering are the 
only adulterations usually practiced, and the 
common notion that calves' brains, chalk 
and such like substances are frequently 
added to milk is a vulgar error. Borax and 
carbonate of soda are sometimes employed as 
preservatives, but in the quantities used do no 
great harm. No easy tests exist by which we 
can with certainty detect the partial removal 
of cream from milk or the addition of water in 
moderate quantity, for the indications of the 
lactometer are not absolutely to be relied upon, 
and the amount of cream measured by volume 
will vary considerably, according to circum- 



The Hygiene of Food and Deink. 79 

stances, so that, if the milk supplied us seems 
of poor quality, it may be necessary to have an 
analysis made and to resort to legal measures 
for relief, if they be provided. Skimmed milk, 
however, sold as such, and at a proper price, is 
a valuable article of food, the sale of which 
should be regulated, but ought not to be pro- 
hibited by law. Of course it is entirely unfit 
for the use of infants. The common notion that 
milk from one cow is to be preferred for in- 
fants' use has nothing to recommend it, the 
mixed milk from a dairy being less likely to 
be unwholesome. Condensed milk is generally 
pure and of a good quality. 

The butter with which we are supplied 
is of varied quality, being sometimes poorly 
made, though genuine, or containing an un- 
due quantity of water or salt, or it may be 
artificial in whole or in part. Oleomargarine 
properly made is probably not an unwholesome 
article of food, but it should be sold on its 
merits and not as butter. It is sometimes quite 
difficult to detect it, though a bit of lamp wick- 



80 Cholera. 

ing dipped in the suspected butter when melted, 
lit and blown out after burning for a few min- 
utes will frequently enable us to recognize the 
sophistication by the unmistakable odor of 
burnt tallow which may be perceived. Cheese 
is a valuable food, capable, in part, of taking 
the place of meat, and is, when well made, 
wholesome, if not too largely eaten. It should 
be made from the whole milk, though the 
much talked of skim- cheeses are not neces- 
sarily so bad as they are thought to be by some. 
Occasionally during the process of ripening 
cheese develops a peculiar poisonous principle 
which has not been isolated by any chemical 
tests, but which renders it highly irritating 
when eaten. There is no way in which this 
danger can be guarded against, but fortunately 
instances of this kind are rare. 

We will now consider those foods which 
are of a vegetable origin. Bread is the staff 
of life, and flour naturally comes first. It 
is of many grades, and the highest priced 
are not always the most economical and nutri- 



TheJIygiene of Food and Deink. 81 

tious, since by some processes of milling much 
of the gluten goes into the middlings and 
bran. Wheat flour is never intentionally 
adulterated, and bread not very frequently, 
though potatoes are sometimes employed 
in its manufacture to cause it to retain more 
water, and alum is occasionally employed to 
whiten that which is made from inferior flour. 
Baking powders, so generally used in making 
biscuits and cakes, are mixtures of bi-carbonate 
of soda, with cream of tartar, acid phosphate 
of lime, alum, tartaric acid and like substances. 
While those made from soda and cream of tartar 
are preferable, little dependence can be placed 
upon the conflicting claims as to purity or im- 
purity put forth by the manufacturers. Pow- 
der sold in bulk is generally of inferior strength 
and should not be used. Oatmeal is an exceed- 
ingly valuable food, being much richer in nitro- 
genous, or tissue-forming matter, than wheat. 
When of good quality and well cooked it is a 
most excellent food for both children and 
adults, especially if eaten with milk or cream. 



82 Choleka. 

Rice is a poorer food, being chiefly starch. It 
should always be steamed and not boiled, for 
boiling extracts much of the gluten in which 
it is already deficient. Fresh fruit and vegeta- 
bles form an essential part of our diet. Only 
well ripened fruit should be eaten, and vegeta- 
bles must be fresh and properly cooked to be 
wholesome. The common notion that the 
free use of tomatoes gives rise to cancer is 
not based on any known facts. Sugar is 
one of the most important food articles. It 
is chiefly obtained from the sugar cane, but 
it is also made from the sugar beet, sap of 
the sugar maple and from sorghum. Granu- 
lated and loaf sugar are almost perfectly 
pure, and the notion that sugar is adul- 
terated with sand, marble dust and the like 
is an error. Low grade sugars are mixed 
with grape sugar (starch sugar or glucose), and 
this is a commercial fraud since the adulterant 
is less sweet than the cane sugar, but there is 
no evidence to show that such sugar is un- 
wholesome. Most syrups consist largely of 



The Hygiene of Food and Dkink. 83 

glucose, and the maple syrup commonly sold 
is not genuine, and, in the manufacture of con- 
fectionery, large quantities of glucose are used 
on account of its low price. Terra alba (gyp- 
sum) is used to a considerable extent in cheap 
candies, and, while not poisonous, it is an in- 
soluble earthy substance not desirable as a 
food. Certain poisonous colors are occasionally 
used by confectioners, and, as a rule, cheap 
and highly colored candies are to be viewed 
with suspicion. Most of the jellies, jams and 
preserves sold in the shops are sheer imitations, 
made from the cheapest, though not necessarily 
unwholesome, materials, and their use is not 
to be recommended. 

Tea and coffee are articles that are fre- 
quently adulterated. Tea, so called, is often 
the merest rubbish, and many teas are 
M faced" with Prussian blue, indigo and 
other substances. Black teas are generally 
purer than green, and in purchasing, if a 
fair price is paid, a good article may generally 
be obtained. Unground coffee is seldom adul- 



84 Cholera. 

terated, but the coffee sold ground generally 
contains chicory (not unwholesome), and the 
cheapest varieties are sometimes made up of 
rye, beans, wheat, peas and the like, with 
more or less of chicory. Pure coffee (ground) 
floats upon water and imparts but little color 
to it, while chicory sinks and colors it rapidly. 
Spices are generally adulterated, but seldom 
with harmful substances. Many of the ground 
spices, as sold in the shops, are largely 
composed of peas, beans, ground cocoanut 
shells, stale ships' bread, etc. Mixtures of 
such substances are manufactured on a large 
scale and sold to dealers for use in the adul- 
teration of spices. Mustard is universally 
mingled with flour and starch, and colored 
generally with turmeric, though sometimes 
with poisonous coloring matters. Vinegar is 
often of inferior strength from an undue ad- 
dition of water, but is very rarely adulter- 
ated with mineral acids, as is commonly sup- 
posed. Olive oil is very largely adulterated 
with lard oil, cotton-seed oil, etc., but these 



The Hygiene of Food and Dkink. 85 

additions are harmless. Cream of tartar, as 
sold in the shops, is generally of very inferior 
quality, consisting in some cases of ninety per 
cent of gypsum. It ought to be purchased of 
reliable apothecaries. 

The wines, malt liquors and ardent spirits 
that we drink are adulterated and falsified 
to a considerable extent, but not with the 
rank poisons that are considered by some to 
be their chief constituents. Many wines, like 
sherry, are artificial mixtures, though not 
necessarily made from deleterious substances. 
Much glucose is used in brewing beers and ales 
to save malt, and there is no real objection 
to this substitution, and other bitters than 
hops are occasionally, though rarely employed. 
Poisonous substances like cocculus indicus 
and nux-vomica are practically never used, 
though we hear much said about them. Dis- 
tilled liquors are chiefly adulterated by dilu- 
tion with water and colored with caramel. 
Much of the brandy, so called, is a mere imita- 
tion of the real article, but the common idea 



86 Cholera. 

that such liquors are manufactured from aqua 
fortis and oil of vitriol is a vulgar error. In the 
compounding of liquors, as in the preparation 
of other food articles, there is dilution, imita- 
tion and other deception, but positively harm- 
ful adulterations fortunately are the exception 
and not the rule. 

We come now, and in conclusion, to speak 
brieily of water and the impurities which 
it may contain, and when we remember that 
many diseases are propagated by the use of de- 
filed waters, and possibly, as regards a certain 
class of diseases, more frequently in this than 
any other way, we have no need to exaggerate 
the importance of the subject. Surface waters 
are generally less palatable than those from 
wells and springs, but unfortunately the color, 
odor and taste afford little indication of the 
real quality. Waters which have percolated 
through the soil are often bright and sparkling, 
but may, nevertheless, be loaded with impuri- 
ties, and waters containing the germs of typhoid 
fever and other filth diseases may be to all ap- 



The Hygiene of Food and Drink. 87 

pearances of very superior quality. As a rule, 
shallow wells in the vicinity of dwellings and 
out-houses are to be viewed with suspicion, 
since they may at any time become specifically 
contaminated, and capable of spreading infec- 
tious diseases. Especially is this true in thick- 
ly populated suburban districts where the wells 
are always in close proximity to privy-vaults 
and cesspools. Under such circumstances rain- 
water collected in clean cisterns, or preferably 
in tanks lined with slate or tinned and burnished 
copper, but never with lead, should be preferred. 
Filtration may improve the appearance of 
a water, but it by no means renders it safe to 
drink, and many filters are, in reality, worse 
than useless. In cases where it is necessary to 
use water of doubtful purity, it should always 
be boiled, and after cooling the clear water may 
be poured off from any sediment which has 
formed. Boiling probably destroys all disease 
germs, and if care is taken to employ only pure 
ice in cooling water which has been boiled, there 
is little risk in its use. 

7 



88 Cholee^. 

The complete analysis of potable waters is a 
laborious undertaking, and can only be per- 
formed by a competent chemist. Even then the 
results obtained are often unsatisfactory, and 
no analysis will enable us to say with certainty 
that a given water is absolutely pure on the 
one hand, or certain to produce disease on the 
other; but an analysis is capable of showing 
different degrees of purity, and if a water is 
certainly defiled wuth animal matter it ought 
not to be used for drinking, even though it 
may be used for a time without producing dis- 
ease. The following superficial tests will aid 
us in forming an opinion as to the quality of a 
water : Add to some of the water in a clean glass 
a few drops of a solution of nitrate of silver 
(strength about twenty grains to an ounce of 
water), and a few drops of nitric acid; if a pre- 
cipitate, or even a decided turbidity is produced, 
chlorides are present in considerable quantity, 
and may be due to sewage contamination. To a 
tablespoonful of the water in a wineglass add 
a drop or two of a solution made by dissolving 



The Hygiene of Food and Dkink. 8^ 

twelve grains of caustic potash and three grains 
of permanganate of potash in a fluid ounce of 
pure water; if the pink color speedily disap- 
pears the water may contain abnormal quanti- 
ties of organic matter. Other things being 
equal the purer waters will keep the tint longest. 
Select a clean glass bottle, holding about a pint, 
and having filled it about two- thirds fall of the 
water, add half a teaspoonful of pure granu- 
lated sugar, cork the bottle and allow it to 
stand in a warm place, and if, at the end of forty- 
eight hours, the contents of the bottle have 
become cloudy, milky or opalescent, the water 
is probably impure. Water which on standing 
for a time in a warm place exhales an unpleas- 
ant odor is likewise to be regarded with sus- 
picion. Of course these tests are by no means 
infallible, and too much dependence must not 
be placed upon them, but they are as reliable 
as any simple tests can be, and if the results ob- 
tained by them are unfavorable, it will be best 
to abandon the supply, if practicable, or have 
a thorough analysis made. On the other hand, 



90 Cholera. 

should these tests fail to show impurity, while 
other evidences point to the water as a cause 
of disease, they should not Jbe allowed to refute 
such evidence, since waters may be of a high 
degree of purity in a chemical sense, and yet 
contain matter which, thougtf the chemist can- 
not recognize it, is capable of giving rise to 
disease. There is little doubt that cholera and 
typhoid fever are propagated "more frequently 
by the use of drinking water to which the ex- 
creta of those suffering from these disorders 
have gained access, than in all other ways com- 
bined, and it behooves us, 'especially at times 
when these diseases are prevalent, or may be- 
come so, to look well to the quality of the 
water which we drink. 



CHAPTER VI. 

DISINFECTION. 

Disinfection is the destroying of those micro- 
organisms, the development of which produces 
decomposition, disease or death. The sub- 
stances by which such destruction is produced 
are called disinfectants. That the sanitary 
application of disinfection is not a matter of 
recent date, is shown by the fact that in 1771, 
during the pest in Moscow, Russian physicians, 
in order to determine the disinfecting power of 
sulphurous acid gas, took the garments in 
which the bodies of several persons dead of the 
pest had been wrapped, and, after subjecting 
them to the fumes of the gas for a definite 
time, caused a number of men condemned to 
death to put them on and wear them; it was 



92 Cholera. 

found that the peculiar power the garments 
formerly possessed of reproducing the pest 
had disappeared. Again in 1785 Berthollet 
made a bleaching powder called "Eau de 
Javelles," so named from the bleaching estab- 
ment where it was first made, and from that 
time to this the powder has been used as a 
disinfectant. Since 1809, when chlorine was 
recognized, this powder has been called by the 
more scientific, but much less euphonious, 
name of hypochlorite of potassa. It is within 
comparatively recent years, however, that dis- 
infection has occupied the prominent position 
accorded to it at present. As the various 
aspects of the "germ theory" are developed, 
the special powers of various substances to 
modify the action of these microscopic germs 
are being investigated very thoroughly. The 
term disinfectant is very loosely used and very 
poorly comprehended by very many j)ersons. 
Anything that will remove a bad odor is by 
them considered to be a disinfectant. It is 
important that this wrong impression should 



Disinfection. 93 

be corrected, because much evil might ensue if 
only a deodorizer were used when a true disin- 
fectant was called for. The market is full of 
patented compounds said, by their manufac- 
turers, to be powerful disinfectants, when in 
truth they are nothing more than preparations 
that will remove bad smells — deodorizers. One 
step higher, if we take Dr. George M. Stern- 
berg's division, we come to a class of sub- 
stances which have the power to prevent putre- 
factive decomposition, but do not destroy the 
vitality of the disease germ; these are called 
antiseptics. Next we come to the true disin- 
fectants, substances which kill the disease 
germs, thus rendering them incapable of prop- 
agation, no matter how favorable the circum- 
stances under which the attempt is made. It 
will be at once perceived that it is upon the 
members of this latter class we place most 
reliance in time of epidemics, or during the 
prevalence of infectious disease, for at such 
times it is not enough that we arrest the growth 
of the disease germs ; our object is to destroy 



D4 Cholera. 

them. The committee of the American Public 
Health Association have made such careful in- 
vestigations and performed such elaborate ex- 
periments to establish some facts which may 
be taken for a basis for operation, and the con- 
clusions reached by them are so very generally 
considered correct that we quote very freely 
from them. The agents recommended as true 
disinfectants are, thus far, only three in num- 
ber, viz. : corrosive sublimate, chlorinated soda, 
or its equivolent chloride of lime, and per- 
manganate of potassa. The reader will at once 
enquire what is done with carbolic acid, cop- 
peras and like substances. Our answer is, the 
fiat has gone forth, they are only antiseptics. 
It must not be supposed that they are to be 
cast away and forgotten because they are no 
longer continued in the list of true disinfectants 
or germicides, not at all; but, as we have said, 
it is important to recognize distinctly the differ- 
ence between the effects produced by members of 
the two classes. Take for example this illustra- 
tion : If from time to time a solution of cop- 



Disinfection. 95 

peras is thrown into a cesspool, putrefactive 
decomposition of the material in it is pre- 
vented, and it does not become offensive; if, 
however, the excreta from a typhoid fever or 
cholera patient gets into the cesspool, the germs 
of either disease will go on developing in spite 
of the copperas, and it becomes a source of in- 
fection; but they will in a very short time be 
killed if a sufficient quantity of any one of the 
substances named as disinfectants be thrown 
freely into the cesspool, and in a very short 
time the infecting material is destroyed. When 
we appreciate the rapidity with which some of 
these germs multiply, we see the necessity for 
their destruction. " It has been calculated by 
Ferdinand Cohn, that if the bacterium termo 
were unimpeded in its propagation, and if one 
were to multiply into two in the first hour, and 
these into four in the second hour, and these 
into eight in the third hour, and so on, the re- 
sult would be 16,000,500 in the first day, and 
281,000,000,000 on the second day, and that in 
five days time the progeny of this little micro 



96 Cholera. 

sco pic body would fill the oceans of the world, 
so wonderfully numerous and fertile are they." 
It will be seen that in such a case partial dis- 
infection will not suffice, for if a single germ 
be left alive it will be multiplied indefinitely. 
Beside the three already mentioned, there are 
two others which deserve mention, and we may 
call them natural disinfectants; these are heat 
and fresh air." The best of all disinfectants is 
fire. Burn up all dangerous things if you can. 
All rags and remnants of food that have been 
in contact with patients afflicted with scarlet 
fever, cholera or other infectious diseases 
should be thrown promptly into the fire. A 
large part of garbage that would soon putrify 
and become dangerous may be burned when 
there is no other ready means of its disposal. 
Every household, however poor, can command 
boiling water. Don't lay aside towels, sheets, 
pillow-cases, pocket-handkerchiefs, night- 
gowns or other articles of the kind that have 
been in contact with the sick, to be washed at a 
convenient or leisure time, but boil them for an 



Disinfection. 97 

hour or two at once. Articles that cannot be 
boiled without spoiling, may be safely and 
effectively baked at a temperature of 240° 
Fahrenheit."* 

In this connection Dr. Sternberg says of the 
relative value of dry and moist heat : " In dry 
air the heat penetrates objects so slowly that 
small packages, such as a pillow or small bundle 
of clothing, are not disinfected after an ex- 
posure of from two to three hours to a temper- 
ature of 140° C. (284 Q F.) Exposure to a tem- 
perature of 140° C. (284° F.) in dry air for a 
period of three hours injures most articles re- 
quiring disinfection (clothing, bedding, etc.) to 
a greater or less degree. In steam, however, 
at a temperature of from 105° to 110° C. (220° 
to 230° F.), we have an agent which quickly 
destroys all living organisms, including the 
most refractory spores. From the experimental 
evidence presented, it is safe to say that the 
temperature of boiling water will quickly de- 
stroy the vitality of all micro-organisms of the 

* Health Maxims— Dr. O. W. Wright. 



98 Cholera. 

class to which all known disease germs belong, 
in the absence of spores. Steam, at the tem- 
perature of 105° C. (220° F.) maintained for 
one or two minutes, or of 110° C. (230° F.) 
maintained for ten minutes, will infallibly de- 
stroy the spores of bacilli, which constitute the 
most difficult test of disinfecting power 
known."* 

Next in general value is fresh air — plenty of 
it, in constant currents. Sunlight should be 
abundantly mixed with it as an adjuvant. 
The oxygen of pure air kindles a slow fire in 
all filth with which it comes in contact. Ozone, 
sometimes abounding in the atmosphere, is 
still more potent. Let it freely into houses, 
cellars, and especially sick rooms. Chloride 
of lime is one of the best, and, when mixed 
with hydrochloric acid, produces a gas fatal to 
every form of germ life. If to chloride of lime 
an equal amount of hydrocloric acid be added, 
there will be produced a gas which, by pene- 
trating every crevice and corner, will reach 

* Medical News, Mar. 14, 1885. 



Disinfection. 99 

what nothing else can. It will be necessary to 
place the dish containing the disinfectant high 
up in the room, because of the density of the gas. 
It must be remembered that this gas has the 
power to destroy metallic surfaces, also to re- 
move color from textile fabrics, and cannot be 
inhaled at all. All articles liable to injury 
should, when possible, be removed from the 
room. Metallic surfaces may be protected by 
oil or varnish placed upon them. After the 
room has been closed for twelve hours, sub- 
jected to the action of this gas, cloths satu- 
rated with ammonia may be introduced for the 
purpose of neutralizing what gas may be 
present. The windows should be opened and 
the air allowed to circulate freely through the 
room for twenty-four hours. The chloride of 
lime itself may be used either in solution or 
powder, but should be kept in tightly corked 
bottles. For privies and cesspools one pound 
of the powder should be used for every thirty 
pounds of matter. The clothing of the patient 
sick with cholera, all linen used in the sick- 



100 Cholera. 

room, before its removal from the room, should 
be saturated with some disinfecting solution; 
but the solution of chloride of lime is not so 
well adapted to this purpose as is that of the 
bichloride of mercury. Of even more impor- 
tance than the disinfecting of the clothing and 
linen is the disinfection of the dejecta of the 
patient. For this purpose the solution of 
which we are now speaking, on account of the 
rapidity of its action, is most valuable. The 
following standard solution is recommended: 
" Dissolve chloride of lime of the best quality 
in soft water, in the proportion of four ounces 
to the gallon. Use one pint of this solution 
for the disinfection of each discharge in 
cholera, typhoid fever, etc. Mix well and leave 
for at least ten minutes before throwing into 
the privy vault or water closet. The same 
directions apply for the disinfection of vomited 
matter. For cesspools and privy vaults use 
one gallon of solution to every gallon of matter. 
Infected sputum should be discharged directly 
into a cup half- full of the solution."* A dis- 

* Medical News, April 18, 1885. 



Disinfection. 101 

infectant somewhat more expensive, and with 
perhaps no special advantages, is that called 
Labarraque's solution, bnt the article sold 
under that name is oftentimes of very inferior 
quality. For those who prefer to use this 
preparation rather than that of chloride of 
lime, the following formula will furnish a good 
article: Take of chloride of lime eighty parts 
and put it into four hundred parts of water, 
keeping in a tightly covered vessel; take of 
carbonate of sodium one hundred and twenty 
parts and mix with four hundred parts of 
boiling water ; when cool, mix the two solutions 
and add water sufficient to make a thousand 
parts ; keep tightly corked. Of this, for 
use, take one part and to it add five parts of 
soft, water; it may be used the same as chloride 
of lime. There is an objection to both of these 
solutions from the fact that they have an un- 
pleasant odor, that of chlorine. To offset this 
they have a value from the fact that they de- 
compose, in place of coagulating, as does the 
bichloride of mercury, albuminoid substances, 



102 Cholera. 

and when such substances appear in the dis- 
charges of the patient, or in any other way, for 
disinfection these disinfectants should be used 
in preference to the bichloride of mercury 
(corrosive sublimate). This latter, while a 
powerful and valuable disinfectant, is very 
poisonous, and the free use of it in the 
family should be attended with extreme 
caution. As a means for disinfecting the 
clothing and linen of the sick-room, as we have 
already said, it is of great value. Where, 
also, for any reason whatever, it is impossible 
to use chlorine gas for the purpose of disin- 
fecting the room after the removal of the 
patient, this will be found a valuable solution 
with which to wash the wood-work, floors, 
cornices and furniture. Indeed, it is advis- 
able to have the rooms thus washed, even 
after fumigation has been resorted to. The 
solution of bichloride of mercury may be made 
by taking equal parts of it and common salt 
and dissolving them in water, the salt in this 
case acts as a solvent; an ounce of this powder 



Disinfection. 103 

may be used to eight gallons of water. It 
must be remembered that this solution becomes 
decomposed and the mercury precipitated by 
coming in contact with copper, lead or tin. A 
wooden tub or earthen crock is a suitable 
receptacle for such a solution. As this sub- 
stance is poisonous, but at the same time odor- 
less and perfectly clear, it might possibly be 
mistaken for clear water. To prevent the pos- 
sibility of this, Dr. Sternberg has suggested 
that there be mixed with it a small portion of 
permanganate of potassa. This imparts to the 
solution a beautiful and very distinctive color, 
and no fluid containing it would be mistaken 
for a potable liquid. His formula is: "Dis- 
solve corrosive sublimate in water in the pro- 
portion of four ounces to the gallon, and add 
one drachm of permanganate of potassa to each 
gallon to give color to the solution. One fluid 
ounce of this solution," he says, " to the gallon 
of water will be a suitable solution for the 
disinfection of clothing. The articles to be 
disinfected must be thoroughly soaked with 



104 Cholera. 

the disinfecting solution and left in it at least 
two hours, after which they may be wrung out 
and sent to the wash." * 

One gallon of this solution, diluted with three 
gallons of water, may be used in privies and 
cesspools in the proportion of one gallon to 
every four gallons of matter, or the powder 
may be used in the proportion of one pound to 
every ^.ve hundred pounds of matter. Perman- 
ganate of potassa has very decided germicidal 
and antiseptic properties, and as a deodorizer it 
is rapid and complete in its action, but it is not 
generally applicable as a disinfectant, because 
of the rapidity with which it is decomposed by 
organic matter. Mixed with a solution of 
bichloride of mercury, it serves the double 
purpose of increasing the disinfecting power of 
the solution, while, at the same time, it throws 
a safeguard around its use. 

We have briefly called attention to the best 
disinfectants; because mention has not been 
made of others, nor stress laid upon some 

* Medical News, April 18, 1885. 



Disinfection. 105 

substances commonly called disinfectants, but, 
by the division adopted in this book, properly 
called antiseptics, it must not be thought their 
value is ignored. They should be used at all 
times when necessary to keep the atmosphere 
sweet and clean, but when infectious diseases 
are present, it is not safe to use any thing that 
is not a germicide as well as an antiseptic. 

In conclusion, the proin£>t and faithful dis- 
charge of sanitary duties by officials and indi- 
viduals is a most essential factor in the preven- 
tion of cholera, and the maintenance of such 
hygienic and sanitary conditions as best pro- 
mote the public health, will make the dread 
disease a matter of history only. 



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